Active NPI
Hassan J Khan, MD
- Diagnostic Radiology Physician
- Winter Park, FL
National Provider Identifier
1083877286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- ME104679
- Practice address
- 111 N Lakemont Ave
Winter Park, FL 32792-3508 - Phone
- (407) 975-3315
- NPI assigned
- Jul 8, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | ME104679 | FL | Primary |
Addresses
Primary practice location
111 N Lakemont Ave
Winter Park, FL 32792-3508
Mailing address
111 N Lakemont Ave
Winter Park, FL 32792-3213
Phone (813) 650-3401
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001429800 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091123000150 | FL | Practitioner - Diagnostic Radiology | 2668511163 |
Reassigns benefits to 7 organizations Practice locations: Jacksonville, FL |
Care Compare profile
Medicare Care Compare- Specialty
- Diagnostic Radiology
- Education
- University of South Florida College of Medicine, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- East Central Florida Outpatient Imaging LLC
Practice addresses (Care Compare)
8037 Topsail PL
Winter Garden, FL 34787-4560
Phone (386) 274-7118
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME104679 | FL | MD | Diagnostic Radiology Physician |
Practice roles (5 of 7)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Medical Imaging Partnership-Jax1 LLC | Current | Accepting new patients | |
| Florida Diagnostic Imaging Center Inc | Diagnostic Radiology | Current | Accepting new patients |
| Precision Imaging St. Augustine, LLC | Current | Accepting new patients | |
| The Medical Imaging Partnership-Jax1 LLC | Current | Accepting new patients | |
| Advanced Imaging of Port Charlotte | Diagnostic Radiology | Past | Accepting new patients |
Locations
7860 Gate Pkwy
Ste 123
Jacksonville, FL 32256
Phone (904) 471-9633
Networks
- Optimum HealthCare HMO Network
- Freedom Health HMO Network
Organizations & group practices 12
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Diagnostic Radiology Physician
- Daytona Beach, FL
- NPI 1245271675
FL
-
- Diagnostic Radiology Physician
- Daytona Beach, FL
- NPI 1063400729
FL
-
- Diagnostic Radiology Physician
- Winter Park, FL
- NPI 1821977182
Diagnostic Radiology
-
- Radiology Clinic/Center
- St Augustine, FL
- NPI 1700130010
-
- Radiology Clinic/Center
- Jacksonville, FL
- NPI 1104849280
-
- Radiology Clinic/Center
- Jacksonville, FL
- NPI 1306535950
-
- Diagnostic Radiology Physician
- Port Charlotte, FL
- NPI 1225361850
Diagnostic Radiology
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215475200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1399852800000",
"number": "1083877286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 N LAKEMONT AVE",
"city": "WINTER PARK",
"state": "FL",
"postal_code": "327923213",
"telephone_number": "813-650-3401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 N LAKEMONT AVE",
"city": "WINTER PARK",
"state": "FL",
"postal_code": "327923508",
"telephone_number": "407-975-3315"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHAN",
"first_name": "HASSAN",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-07-08",
"last_updated": "2014-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "FL",
"license": "ME104679",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001429800",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Winter Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.